Provider Demographics
NPI:1558574228
Name:HOLLEN, JEFFREY C (PTA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:HOLLEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3138
Mailing Address - Country:US
Mailing Address - Phone:954-921-2497
Mailing Address - Fax:
Practice Address - Street 1:747 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4055
Practice Address - Country:US
Practice Address - Phone:954-316-1131
Practice Address - Fax:954-316-1141
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20815225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant